Surgical robotic access system

ABSTRACT

The surgical robotic access system provides access for robotic instruments and/or actuators including the introduction, operation and withdrawal of such robotic manipulators into a body cavity without permitting the escape of pressurized fluid or gas. The surgical robotic access system also provides a multi-faceted range of movement without touching or effecting pressure on the opening in the patient&#39;s body cavity.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No. 62/219,042, filed Sep. 15, 2015, the entire disclosure of which is hereby incorporated by reference as if set forth in full herein.

BACKGROUND

This application relates generally to surgical access devices and more particularly to surgical access systems for surgical robotics.

Surgical robotics has been gaining acceptance and seeks to replace or assist in particular surgical procedures. In particular, some assistance provided by surgical robotics seeks to assist in complicated or repetitive tasks. However, surgical robotics provides challenges where procedures performed by a surgeon without robotic assistance would not encounter. One such area is with surgical access devices used in surgery to facilitate the introduction of various surgical instruments into natural biological vessels, conduits, orifices, cavities, and other interior regions of the body. Surgical robotic instruments or actuators impose other restrictions that are not encountered or not a limitation with other surgical instruments or actuators, e.g., a surgeon's hand. Such challenges are further exasperated by the limited or restricted surgical area or environment. For example, the surgical environment may require an introduction of laparoscopic or particular sized instruments or actuators into the abdomen of the body and/or introduced into regions that include fluid or gas under pressure.

SUMMARY

In accordance with various embodiments, a surgical robotic access system is provided. The surgical robotic access system provides surgical robotic instruments and/or actuators access into a patient's body. In various embodiments, the surgical robotic access system comprises a surgical robotic access platform having a proximal portion disposed externally to a patient's body and a distal portion positioned within a patient's body. The proximal portion of the surgical robotic access platform includes a flexible seal. A robotic insertion tube has a proximal end disposed away from the proximal portion of the surgical robotic access platform and has a distal end embedded in the flexible seal of the surgical robotic access platform. The robotic insertion tube also has a lumen extending between the proximal end of the robotic insertion tube to the distal end of the robotic insertion tube through which a surgical robotic manipulator is insertable therethrough and through the flexible material.

In various embodiments, the surgical robotic access system comprises a sealing cap disposed externally to a patient's body in which the sealing cap includes a flexible seal. The surgical robotic access system also comprises a retractor with an outer ring removably connected to the sealing cap and an inner ring arranged to be positioned within the patient's body and a robotic insertion tube comprising an upper or outer access connector and a lower or inner access connector. The outer access connector is arranged to be removably coupled to a robotic sleeve and the inner access connector is embedded in the flexible seal of the sealing cap. The robotic insertion tube has a lumen extending through the outer access connector and the inner access connector and the flexible seal covering a portion of the lumen extending through the inner access connector and through which a surgical robotic manipulator insertable through the lumen is insertable through the flexible seal covering the portion of the lumen.

In various embodiments, the surgical robotic access system comprises a sealing cap disposed externally to a patient's body in which the sealing cap includes a flexible seal. The surgical robotic access system also comprises a robotic insertion tube comprising an outer access connector and an inner access connector. The outer access connector is arranged to be removably coupled to a robotic sleeve through which a robotic instrument is insertable therethrough and the inner access connector is embedded in the flexible seal of the sealing cap to permanently affix the inner access connector of the robotic insertion tube to the flexible seal. The flexible seal has a first region with a first thickness surrounding the robotic insertion tube and a second region having a second thickness disposed below the inner access connector of the robotic insertion tube. The first thickness of the flexible seal is greater than the second thickness of the flexible seal to provide a predetermined insertion force.

In various embodiments, the surgical robotic access system comprises a sealing cap disposed externally to a patient's body in which the sealing cap includes a flexible seal. The surgical robotic access system also comprises a robotic insertion tube comprising a first outer access connector and an inner access connector. The first outer access connector is removably coupled to a first robotic sleeve through which a first robotic manipulator is insertable therethrough and the inner access connector is embedded in the flexible seal of the sealing cap to permanently affix the robotic insertion tube to the flexible seal. A second outer access connector is removably coupled to a second robotic sleeve through which a first robotic manipulator is insertable therethrough. The first and second outer access connectors are arranged to be removably coupled to the inner access connector of the robotic insertion tube in that the first and second outer access connectors are interchangeable with the inner access connector.

Many of the attendant features of the present invention will be more readily appreciated as the same becomes better understood by reference to the foregoing and following description and considered in connection with the accompanying drawings in which like reference symbols designate like parts throughout.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a disassembled view of a surgical robotic access system in accordance with various embodiments.

FIG. 2 is a perspective view of a surgical robotic access system in accordance with various embodiments with portions of the system shown transparent.

FIG. 3 is a side view of a surgical robotic access system in accordance with various embodiments with portions of the system shown transparent.

FIG. 4 is a perspective view of a surgical robotic access system in accordance with various embodiments with portions of the system shown transparent.

FIG. 5 is a top view of a surgical robotic access system in accordance with various embodiments.

FIG. 6 is a top view of a surgical robotic access system in accordance with various embodiments with portions of the system shown transparent.

FIG. 7 is a top view of a surgical robotic access system in accordance with various embodiments with portions of the system shown transparent or removed.

FIG. 8 is a side view of a sealing cap of a surgical robotic access system in accordance with various embodiments.

FIG. 9 is a side view of a sealing cap of a surgical robotic access system in accordance with various embodiments with portions of the system shown transparent.

FIG. 10 is a perspective view of a sealing cap of a surgical robotic access system in accordance with various embodiments.

FIG. 11 is a perspective view of a sealing cap of a surgical robotic access system in accordance with various embodiments.

FIG. 12 is a bottom view of a sealing cap of a surgical robotic access system in accordance with various embodiments.

FIG. 13 is a perspective view of a robotic insertion tube of a surgical robotic access system in accordance with various embodiments.

FIG. 14 is a side view of a robotic insertion tube of a surgical robotic access system in accordance with various embodiments.

FIG. 15 is a perspective view of a robotic insertion tube of a surgical robotic access system in accordance with various embodiments.

FIG. 16 is a perspective view of a robotic insertion tube of a surgical robotic access system in accordance with various embodiments.

FIG. 17 is a perspective view of a sealing cap of a surgical robotic access system in accordance with various embodiments with portions of the sealing cap shown transparent or removed.

FIG. 18 is a perspective view of a sealing cap of a surgical robotic access system in accordance with various embodiments with portions of the sealing cap removed.

FIG. 19 is a cross-sectional view of a sealing cap of a surgical robotic access system in accordance with various embodiments with portions of the sealing cap removed.

FIG. 20 is a cross-sectional view of a sealing cap of a surgical robotic access system in accordance with various embodiments.

FIG. 21 is a perspective view of a surgical robotic access system in accordance with various embodiments with a robotic sleeve connected thereto and with portions of the sealing cap shown transparent.

FIG. 22 is a perspective view of a surgical robotic access system in accordance with various embodiments with a robotic sleeve connected thereto and with portions of the sealing cap shown transparent.

FIG. 23 is a perspective view of a surgical robotic access system in accordance with various embodiments with a robotic sleeve and with portions of the sealing cap shown transparent.

FIG. 24 is a cross-sectional view of a surgical robotic access system in accordance with various embodiments.

FIG. 25 is a top view of a surgical robotic access system in accordance with various embodiments.

FIG. 26 is a cross-sectional view of a surgical robotic access system in accordance with various embodiments.

FIG. 27 is a top view of a surgical robotic access system in accordance with various embodiments.

FIG. 28 is a cross-sectional view of a surgical robotic access system in accordance with various embodiments.

FIG. 29 is a top view of a surgical robotic access system in accordance with various embodiments.

DETAILED DESCRIPTION

In accordance with various embodiments, a surgical robotic access system provides access for surgical robotic manipulators that includes but is not limited to instruments, actuators and/or operative portions of a surgical robotic system. The robotic manipulators are robotically controlled by the surgical robotic system autonomously or through assistance of a surgeon without a surgeon in direct contact or physically grasping the surgical robotic manipulator. The surgical robotic access system provides for the introduction, operation and withdrawal of the surgical robotic manipulators into a body cavity without permitting the escape of pressurized fluid or gas. The surgical robotic access system also provides a multi-faceted range of movement without touching or effecting pressure on the opening in the patient. The surgical robotic access system in various embodiments provides laparoscopic or single site access, insufflation and/or smoke evacuation.

In accordance with various embodiments, as shown for example in FIGS. 1-29, the surgical robotic access system includes a surgical robotic access platform having a sealing cap 5 removably coupled to a retractor or protector 20. The sealing cap in various embodiments includes a robotic insertion tube 50. The robotic insertion tube provides access for surgical robotic manipulators, e.g., surgical robotic instruments or actuators. The sealing cap 5 comprises a flexible seal 15 that in various embodiments is made of a flexible material such as a gel material. The robotic insertion tube is embedded in flexible seal. By embedding the robotic insertion tube in the flexible seal, any forces that may dislodge the tube is eliminated or greatly reduced.

As shown, for example, in FIGS. 14-16, the robotic insertion tube 50 includes an inner access connector 55 and an outer access connector 58. In various embodiments, the inner access connector is embedded in the flexible seal 15. In various embodiments, the inner access connector is tubular or cylindrical extending from a proximal end 52 a to a distal end 52 b and connects to or extends into a distal flange or base 53. Within the distal base or at the distal end of the inner access connector are a plurality of apertures 54 that provide access points or anchors to allow the flexible seal 15 to attach and hold the distal base and the distal end of the inner access connector in place and embedded in the flexible seal. The flexibility or resiliency of the flexible seal however allows the inner access connector 55 to float, pivot or move in various directions unhindered but limited within the inner diameter or area delimited by the sealing cap 5. However, the inner access connector is embedded or otherwise fixed within or irremovable from the flexible seal and thus cannot be removed or dislodged from the flexible seal.

The inner access connector 55 in various embodiments extends only partially through the flexible seal. As such, the flexible seal 15 of the sealing cap is disposed below or under portions of the inner access connector. The inner access connector defines or delimits an access passageway or lumen with an inner diameter 35 through which a robotics manipulator can extend there through and through the flexible seal. The flexible seal provides an instrument seal around or sealingly engages the outer surface of the inserted robotic manipulator as the manipulator is inserted, utilized or withdrawn from the inner access connector. The flexible seal also provides a zero seal in various embodiments in the absence of a robotic manipulator inserted in or through the inner access connector. Such seals prevent an escape of gas or fluids. In various embodiments, as shown for example in FIG. 14, the inner access connector defines an outer diameter 36 that is greater than the defined inner diameter 35. The outer diameter 36 is similar to or equal to the outer diameter of the outer access connector 58. Similarly, the inner diameter 35 of the inner access connector is similar to or equal to the inner diameter of the outer access connector. The distal base 53 of the inner access connector also defines a secondary or maximum outer diameter 37 that is greater than the outer diameter 36 to further assist in the securement of the inner access connector to the flexible seal.

In various embodiments, as shown for example in FIGS. 17-19, the flexible seal has a cavity 151 disposed between the inner periphery of the inner access connector of the robotic insertion tube. As such, in various embodiments, the flexible seal has a predetermined or predefined maximum height 46 and where the inner access connector is embedded in the flexible seal, the flexible seal has a reduced height 47 relative to the surrounding flexible seal. This cavity or reduced portion of the flexible seal (e.g., reduced height, area or volume of flexible seal) is within and where the inner access connector is attached thereto. As such, the diameter or width of the cavity 151 is equal to the outer diameter 36 of the inner access connector. Also, the maximum diameter or width of the entire flexible seal is significantly greater than the diameter or width of the cavity 151. The cavity provides an area or free region or space for the flexible seal to displace as a surgical robotic manipulator is inserted there through and thereby easing or reducing insertion force. The displacement area however is also limited or confined by the inner periphery of the inner access connector and thus biases or causes the flexible seal to tend to seal against the inserted surgical robotic manipulator. The cavity also provides limited displacement of the flexible seal when pressurized from gases within the body cavity to further enhance the seal with or without a manipulator inserted there through.

The flexible seal disposed below the robotic insertion tube, e.g., the reduced portion of flexible includes a slit 152 to assist in insertion of a manipulator and sealing against the manipulator or in the absence of the manipulator. In various embodiments, the slit 152 is a single slit or a plurality of slits with one slit 153 orthogonal or angled from another slit 152 and positioned deeper or lower within the flexible seal than the other slit 152. The reduced portion of flexible seal also limits and thus predefines the amount of material the surgical robotic manipulator will encounter upon contact and insertion. With this predefined and constant amount, the forces needed by a surgical robotic manipulator to be inserted into and through the flexible seal can be predefined or determined to provide haptic or tactile feedback to the surgical robotic system to consistently identify when a surgical robotic manipulator has been inserted initially, partially and completely into the flexible seal, through the flexible seal or withdrawn from the flexible seal despite the geometry of the tips or distal end of the manipulator. In various embodiments, the distance or height 45 from the top or proximal end of the robotic insertion tube 50 to the inner surface 160 of the flexible seal 15 is greater than the maximum height 46 of the flexible seal 15. In various embodiments, the surgical robotic system includes a robotic sleeve surrounding and/or sealing or protecting the robotic manipulator. As such, this distance or height or difference in distance or height increases access for the robotic sleeve and enhances coupling of the robotic sleeve and freedom of movement of the robotic sleeve and the robotic insertion tube embedded in the flexible seal 15.

In various embodiments, the inner access connector has a distal or inner end 53 embedded in the flexible seal 15 and a proximal or outer end 52 that is not embedded in the flexible seal and thus is disposed outside, proximate or above the outer surface 159 of the flexible seal. The distal end of the inner access connector does not extend through the flexible seal and thus is disposed above or doesn't extend pass or through the inner surface 160 of the flexible seal. The flexible seal seals the opening through the inner access connector and the plurality of apertures around the inner access connector.

The flexible seal in various embodiments, as shown for example in FIGS. 1-12, is contained or attached to a ring 11 and in various embodiments an insufflation port 14, an evacuation port 12 or both are disposed there through and through the flexible seal to access the body cavity. As such, gas or fluid such as insufflation gas can be externally supplied via an inlet 141 of the insufflation port 14 from a gas source outside or external to the patient and the surgical robotic access system into the patient through an outlet 142 of the insufflation port while the flexible seal prevents any gas or fluid from escaping. Similarly, gas or fluid such as smoke may be extracted from within the patient through the inlet 122 of the evacuation port 12 and pulled out externally through an outlet 121 of the evacuation port 12 into an appropriate canister, suction or evacuation system to properly dispose of the potentially harmful or disruptive gas or fluid. In various embodiments, an outer portion or periphery of the flexible seal is coupled to the ring 11 and in one embodiment is molded to a plurality of apertures disposed along the periphery of the ring. In various embodiments, the ring 11 of the sealing cap includes a pivotably coupled latch 157 along with a stationary ledge or flange 156 to assist in removably coupling the sealing cap to the protector. In various embodiments, the ring and flexible seal are made of the same material and thus together form a monolithic structure.

In the illustrated embodiment, a raised portion 158 of the flexible seal surrounds the cavity 151 to further secure or reinforce the attachment of the robotic insertion tube to the flexible seal. In various embodiments, the raised portion is removed to provide the flexible seal a uniform height or thickness throughout the seal. In various embodiments, a center cavity 154 is disposed within the cavity 151 to further assist in the insertion of a manipulator and sealing against the manipulator or in the absence of the manipulator. As such, the center cavity provides another reduced layer of thickness or increased flexibility relative to the surrounding cavity 151 and the surrounding flexible seal, e.g., the raised portion of flexible seal or the material within the cavity or between the cavity and the edge or outer periphery of the sealing cap.

In various embodiments, the inner and outer access connectors 55, 58 of the robotic insertion tube 50 are separate components. In various embodiments the inner access connector remains fixed and unchanged while the outer access connector may be disconnected and replaced or interchanged with another outer access connector with a different robotic coupling interface. As such, in various embodiments, the inner access connector and the outer access connector include mating connections 51, 56 such as threading, snaps or the like to removably couple the outer and inner access connectors together. Accordingly, the outer access connector can be interchanged with other outer access connectors that provide the associated connection particular for a specific robotic manipulator and/or sleeve. For example, FIG. 16 illustrates an outer access connector 58′ similar to the outer access connector 58 but having apertures 60 to releasably connect to tabs or detents of a different robotic coupling interface of a different robotic sleeve. The apertures 60 do not extend into the lumen of the outer access connector thereby maintaining the seal integrity within the robotic insertion tube. Other portions of the outer access connector may also vary such as the seal on it outer surface along with different sizes and shapes to accommodate the varied coupling interface for other robotic sleeves. The different or varied robotic sleeves may be used for or to identify different robotic manipulators or other identifying indicia of the robotic manipulator operation, surgical robotic system or surgical procedure.

In cases where the outer access connector is permanently affixed to or not otherwise removable from the inner access connector to enhance stability of the robotic insertion tube, to interchange different outer access connectors or in particular different robotic coupling interfaces of the outer access connectors to accommodate different robotic sleeves, the entire sealing cap is replaceable with a different sealing cap. As such, a first sealing cap can include an inner access connector embedded in the flexible seal of the sealing cap with an outer access connector affixed to the inner access connector and a separate second sealing cap can include an inner access connector embedded in the flexible seal of the sealing cap with an outer access connector affixed to the inner access connector with this outer access connector having a different or specialized robotic coupling interface relative to the other robotic coupling interface of the outer access connector of the first sealing cap. As such, the first sealing cap can be interchanged with the second sealing cap as required for the corresponding needed robotic coupling interface. This can also be the case for access connectors that can be separated to provide alternative connections or quick changes if desired or required by the particular surgical or robotic system or procedure.

The outer access connector 58 in various embodiments provides a target area that is identifiable by the surgical robotic system to sense and/or locate for the insertion of a surgical robotic manipulator there through. In various embodiments, the outer access connector includes a robotic coupling interface configured to, engage, mate or sealingly mate with a corresponding robotic coupling interface of a robotic sleeve 500. In FIGS. 21-23, for example, the robotic coupling interface of the outer access connector includes a plurality of pins 59 and the robotic coupling interface of the robotic sleeve includes one or more slots 503 within a rotatable collar 502 to engage with the plurality of pins to form a bayonet like connection between the outer access connector and the robotic sleeve. In various embodiments, the robotic sleeve, the outer access connector or both includes a seal to seal the connection between the robotic sleeve and the robotic insertion tube. In one embodiment, the seal includes one or more compressible seals such as O-ring 57 disposed partially within one or more grooves in the outer surface of the outer access connector 58. In various embodiments, the robotic sleeve 500 is attached by a user to the outer access connector 58. The robotic manipulator, e.g., exemplary robotic instrument 504, is robotically controlled by a surgical robotic system autonomously or through assistance of a surgeon without a surgeon in direct contact or physically grasping the surgical robotic manipulator. In various embodiments, both the robotic sleeve and the robotic manipulators are robotically controlled. With the robotic sleeve 500 attached to the outer access connector 58, the surgical robotic system can identify or has a fixed or well-defined location of the surgical robotic access system and thus the opening in the patient. Additionally, the location is simplified by limiting the frame of reference relative to the patient. The surgical robotic manipulator can be maneuvered through the flexible robotic housing or tube 501 and collar 502 of the robotic sleeve 500 and into and through the surgical robotic access system without potential missteps as to the location of the opening of the patient.

In various embodiments, the outer access connector and inner access connector are integrated or locked together to form a single monolithic structure and/or made from the same material. In various embodiments, the outer access connector is adhered to the inner access connector. In various embodiments the outer access connector is removably coupled to the inner access connector, e.g., via snaps, tabs, pins, slots or other similar connections and as such the outer access connector can be removed if not needed or interchanged with another outer access connector with a different coupling interface as may be needed with a different robotic sleeve, manipulator or system. The robotic sleeve provides flexibility and/or protection to the surgical robotic manipulator extendable through and out the distal end of the sleeve. The outer access connector to the robotic sleeve connection ensures that the surgical robotic system remains connected to the surgical robotic access system and thus reduces or eliminates the need for the surgical robotic system to locate the opening in the patient or the surgical robotic access system.

The distal ends of the surgical robotic manipulator in various embodiments are removable and hot swappable with other distal ends of the surgical robotic manipulator that are arranged to preform specific surgical functions, such as stapling, electro-cautery, grasping, viewing, cutting and the like. In various embodiments, the outer access connector provides a fixed platform and seal for the robotic sleeve. The robotic sleeve remains static and in various embodiments the robotic coupling interface with the robotic sleeve and outer access connector also remains static. The surgical robotic manipulators can vary in shape and sizes and thus the inner access connector including the reduced or isolated flexible seal provides an adaptable yet static sealing arrangement to seal against the varied shapes and sizes of the surgical robotic manipulators or in the absence of a surgical robotic manipulator. The flexible seal also does not damage or disrupt the surgical robotic manipulator. The flexible seal surrounding the inner access connector also facilitates the seal with the opening in the body and allows freedom of movement of the outer access connector which facilitates the seal with or to robotic sleeve and manipulator and reduces potential damage to the robotic sleeve and/or manipulator due to off axis movements.

In various embodiments, a surgical robotic access system provides a double seal arrangement for a surgical robotic manipulator to be inserted there through or in the absence of a manipulator. The surgical robotic access system in various embodiments includes an outer access connector to removably attach to and seal with a robotic sleeve and an inner access connector to fixedly attach the outer and inner access connectors to a sealing cap attached to the patient and disposed over and sealing the opening in the patient. The flexible seal of the sealing cap in which the inner access connector is embedded or fixed allows freedom of movement of the outer and inner access connectors without adding stress or tension on the surgical robotic manipulator, robotic sleeve or the patient. The flexible seal within and/or below the inner access connector provides a seal for a surgical robotic manipulator to be inserted there through or in the absence of a manipulator inserted through the flexible seal. The reduced portion of the flexible seal defined and/or confined by the inner access connector provides a consistent density or consistency to provide a predefined or pre-known or predictable insertion force that may be used to generate haptic feedback or other similar sensor information to be recognized by the surgical robotics system to identify and/or simulate the insertion and withdrawal of the surgical robotic manipulator.

The sealing cap 5 of a surgical robotic access platform in various embodiments is incorporated with or removably attached to a retractor or protector 20 that provides retraction and/or protection of the incision or opening in the patient. In various embodiments, the retractor includes a sleeve, sheath or tube 22 extending between an inner ring 23 placed inside the patient and an outer ring 21 placed outside the patient. Both rings can be rigid, flexible or any combination thereof. The sheath is flexible and cylindrical. In various embodiments, the sheath has another shape, such as an oval or a more complex shape, is adjustable, is transparent or any combinations thereof. In various embodiments, the length of the sheath is adjustable by varying the location of the outer and inner rings or by gathering or winding portions of the sheath around the outer ring, the inner ring, an adaptor, other ring or the like and any combination thereof. In various embodiments, the sheath is non-adjustable defining a fixed length and diameter access channel. In various embodiments, the sheath includes one or more coatings such as a lubricious coating, anti-microbial coating or both. Examples of sealing caps, retractors and/or protectors are described in U.S. Patent Publication No. 2007/0088204 A1, the disclosure of which of incorporated by reference as if set forth in full herein. Examples of a flexible seal or material including gel material are described in U.S. patent application Ser. No. 10/381,220, filed Mar. 20, 2003, the disclosure of which is hereby incorporated by reference as if set forth in full herein.

In various embodiments, the sealing cap covers the proximal or outer portion of the retractor/protector. In various embodiments, the sealing cap provides additional access areas or portions. In the illustrated embodiment, the sealing cap includes a flexible seal or cover made of a flexible material, e.g., gel material, surrounding the robotic or central insertion tube and through which instruments may be inserted directly there through for additional access into the patient. In various embodiments, 12 mm and 5 mm removable access ports 38, 39 are provided for auxiliary surgical instruments or surgical robotic manipulators and are inserted around the robotic insertion tube. In various embodiments, the removable access ports comprise of a cannula with an attached or integrated seal assembly with an instrument seal, zero seal or both. The cannula in various embodiments having one or more support structures on the outer surface of the cannula to removably secure the removable access port to the flexible seal. In various embodiments, auxiliary surgical instruments are insertable directly through the flexible seal in portions around or adjacent the robotic insertion tube. The flexible seal provides a seal around or sealingly engages an outer surface of the surgical instruments as the instrument is inserted, utilized or withdrawn from the flexible seal around the inner access connector and a seal in various embodiments in the absence of a surgical instrument inserted in the flexible seal around the inner access connector.

The retractor/protector of a surgical robotic access platform provides a stable platform to connect the sealing cap to the patient. The stable platform allows movement of the robotic insertion tube without or reducing any additional movement or forces caused by any movement of the robotic insertion tube in the flexible seal. As such, the flexible seal reduces or dissociates movement of the flexible seal caused by movement of the robotic insertion tube relative to the rest of the sealing cap and the patient and the sealing cap attached to the retractor/protector further dissociates movement of the sealing cap on the patient caused by movement of the flexible seal of the sealing cap. The retractor/protector also atraumatically retracts the opening in the patient to increase range of access or mobility of the robotic manipulators and positions the tissue, around and through the opening, away from potential contact or trauma from the surgical robotic manipulators.

In various embodiments, an instrument shield or retractor shield 25 is provided to prevent or reduce potential damage to the retractor or protector and/or direct off-axis instruments towards the center or opening in the patient. In various embodiments, the sealing cap may be connected directly to the patient via sutures or adhesive and may be provided with or without the retractor, shield or both. In various embodiments, the surgical robotic access system provides access into a patient's body cavity for a 22 mm diameter surgical robotic manipulator. The surgical robotic access system provides a seal (zero-seal) when the robotic manipulator is not inserted through the surgical robotic access system. The surgical robotic access system also provides a seal (instrument seal) when the robotic manipulator is inserted through the surgical robotic access system. The seal prevents the loss or escape of fluids or gases. The surgical robotic access system in various embodiments also provides access for introducing or removing of gas or fluids such as insufflation gas, smoke or the like. The surgical robotic access system provides protection from distal tips of the robotic manipulator from damaging the surgical robotic access system. The surgical robotic access system in various embodiments provides auxiliary ports, e.g., a 5 mm, 12 mm or other dimensioned ports or access for similarly sized surgical instruments.

In various embodiments, as shown for example in FIGS. 24-25, a surgical robotic access system is provided in which a sealing cap includes protectors or shield leaves 31 to protect the flexible seal 15 attached to or integrated with a ring, cap or cover 11. In various embodiments, the protectors are embedded in the flexible seal below the robotic insertion tube 50 and inside the inner periphery of the sealing cap 5. In various embodiments, the protectors are positioned between the distal end of the robotic insertion tube and the inner surface of the flexible seal. The protectors are confined within the area or space adjacent to the robotic insertion tube to allow additional access through the surrounding flexible seal as well as to allow freedom of movement of the flexible seal unencumbered or obstructed by the protectors. The flexible seal in one embodiment is a gel material and in various embodiments an upper surface of the protectors are exposed within the lumen of the robotic insertion tube and a lower and/or side surfaces of the protectors are surrounded by or directly attached and embedded in the flexible seal.

The protectors in one embodiment are cast into the flexible seal to protect or reinforce the flexible seal or material from being torn or punctured by the tips of the surgical robotic manipulators in such a way to effectively disrupt or make ineffective the zero sealing or instrument sealing capabilities of the sealing cap In various embodiments the protectors are made out of a soft and durable material, such as LDPE, to provide a lubricious surface for the tips of the robot manipulators to ride against during insertion or withdrawal of the robot manipulators. In various embodiments, the protectors are made from a material different, more durable and rigid or any combination thereof than the material of the flexible seal. In various embodiments, the protectors 31 are a plurality of planar curved or angled plastic or fabric sheets. In various embodiments, two protector sheets, each identical and mirror images of each other, meet together at an edge and in various embodiments over a midline of flexible seal or above the slit. The protectors having one edge elevated above the edge at the midline of the flexible seal provide a tapered entry to facilitate movement of the protectors and to direct the inserted robotic manipulator towards the slit in the flexible seal. In various embodiments, the flexible seal or material directly under the protectors are correspondingly shaped and sized to accommodate the shape and size of the protectors.

In various embodiments, the robotic insertion tube 50 comprises an outer access connector 58 that includes a robotic coupling interface such as bayonet pins and in various embodiments an inner access connector 55 connected to the outer access connector with the inner access connector cast or molded into the flexible material and in various embodiments above the protectors. The outer access connector in various embodiments has an O-ring fitted around the outer periphery of the outer access connector to provide a seal with a mating end or robotic coupling interface of a surgical robotic sleeve. The outer access connector as such maintains a seal with the robotic sleeve even when the seal in the flexible seal is disrupted by the insertion of a robot manipulator.

In various embodiments, as shown for example in FIGS. 26-27, a double duckbill seal 41 is cast into the flexible seal 15 to provide an additional or separate zero seal or seal in absence of a surgical robotic manipulator. The duckbill seal in various embodiments is made of a material different from the material of the flexible seal 15. The duckbill seal is compressible by the surrounding flexible seal to further enhance the seal of the duckbill seal. In various embodiments, the duckbill seal does not extend through the flexible seal and instead is completely embedded in the flexible seal to further enhance the seal of the sealing cap and the duckbill seal. The protectors, illustrated in FIGS. 24-25, may be included and may proceed the duckbill seal.

In various embodiments, as shown for example in FIGS. 28-29, a surgical robotic access system is provided including robotic insertion tube 50 embedded in a flexible seal 15 of a sealing cap 5, 12 mm trocar or access port 71 with an additional stopcock 14 and a simplified/exemplified 5 mm auxiliary port 38. In various embodiments, the robotic insertion tube includes a duckbill seal 61 that provides a separate or additional zero seal for the robotic insertion tube. In the illustrated embodiment, the robotic insertion tube includes an evacuation and/or insufflation port 12 to remove or introduce gas, e.g., insufflation gas, to or from an external source through the robotic insertion tube and from or into the patient's body cavity. As such, the duckbill seal also provides a zero seal as gas or fluids are removed and/or introduced. In various embodiments the robotic insertion tube and the access ports are utilized together to increase triangulation manipulation or viewing for the surgical procedure.

In accordance with various embodiments, the dashed line 18 represents an exemplary incision size of the patient and in which the robotic insertion tube and the other ports are delimited or confined within. The dashed lines 24 represents or exemplifies the protector and its film or sheath that may be twisted prior to its insertion into the opening in the patient. The film twisted can further assist in sealing the opening of the patient. In various embodiments, the dashed lines 28 represent or exemplify the body wall and the sheath of the retractor retracting the opening in the patient to ease access into the patient. In the illustrated embodiments, one or more of the components are shown transparent or translucent to better show some of the underlying components or features otherwise hidden by the flexible seal or sealing cap or other portions thereof. In various embodiments, the dashed line 18 outlines or exemplifies a different consistency or flexibility of the flexible seal relative to the surrounding material and in various embodiments the flexible seal within the dashed line 18 is firm or more rigid relative to the surrounding material and thus moves or translates freely relative to the ring while the robotic insertion tube remains static relative to the flexible seal immediately surrounding the tube. The dashed lines 3, 5 generally represent or exemplify the upper and lower surfaces of the body wall of a patient. The dashed line 7 represents or exemplifies the mid-line or longitudinal axis of the surgical robotic access system and in various embodiments represents an initial incision or opening in the patient.

In the illustrated embodiments, it is exemplified that the sealing cap may have different sizes and dimensions along with the robotic insertion tube. The dimensions and sizes may be dictated or determined based on the surgical procedures or the surgical robotic system. Similarly, the shape and materials of the access system may vary to optimize the surgical site space or connectivity to the surgical robotic system. The robotic or central insertion tube although provided as a tube or cylindrical may be of varied shapes and dimensions such as hour-glass, frustoconical or the like to optimize the surgical site space or sealing engagement with surgical robotic instruments or the sealing cap.

In various embodiments, the surgical robotic access system provides a consistent outer access connector and seal for a robotic sleeve and a consistent inner access connector and seal for a surgical robotic manipulator. Throughout a surgical procedure, the surgical robotic manipulator may be interchanged with other surgical robotic manipulator each having differing or varying geometry and/or dimensions.

The above description is provided to enable any person skilled in the art to make and use the surgical robotic access system described herein and sets forth the best modes contemplated by the inventors of carrying out their inventions. Various modifications, however, will remain apparent to those skilled in the art. It is contemplated that these modifications are within the scope of the present disclosure. Different embodiments or aspects of such embodiments may be shown in various figures and described throughout the specification. However, it should be noted that although shown or described separately each embodiment and aspects thereof may be combined with one or more of the other embodiments and aspects thereof unless expressly stated otherwise. It is merely for easing readability of the specification that each combination is not expressly set forth. It is therefore also to be understood that the system or devices may be practiced otherwise than specifically described, including various changes in the size, shape and materials. Thus, embodiments described should be considered in all respects as illustrative and not restrictive. 

The invention claimed is:
 1. A surgical robotic access system providing robotic manipulator access into a patient's body, the surgical robotic access system comprising: a sealing cap arranged to be disposed externally to a patient's body, the sealing cap including a flexible seal; a retractor comprising an outer ring removably connected to the sealing cap and an inner ring arranged to be positioned within a patient's body; and a robotic insertion tube comprising an outer access connector and an inner access connector, the outer access connector removably coupled to a robotic sleeve and the inner access connector embedded in the flexible seal of the sealing cap, the robotic insertion tube having a lumen extending through the outer access connector and the inner access connector and the flexible seal covering a portion of the lumen extending through the inner access connector and through which a surgical robotic manipulator insertable through the lumen is insertable through the flexible seal covering the portion of the lumen; wherein the retractor further comprises a sheath connecting the outer ring of the retractor to the inner ring of the retractor, the sheath having an adjustable length.
 2. The system of claim 1 wherein the inner access connector of the robotic insertion tube is embedded in the flexible seal to permanently affixed the inner access connector of the robotic insertion tube to the flexible seal.
 3. The system of claim 2 wherein the outer access connector of the robotic insertion tube is removably connected to the inner access connector of the robotic insertion tube.
 4. The system of claim 2 wherein the outer access connector of the robotic insertion tube includes a robotic coupling interface to sealingly engage a corresponding robotic coupling interface of the robotic sleeve.
 5. The system of claim 2 wherein the outer access connector of the robotic insertion tube includes a plurality of pins extending from an outer surface of the outer access connector of the robotic insertion tube and the robotic sleeve having at least one slot to engage at least one pin of the plurality of pins of the outer access connector to removably couple and sealingly engage the outer access connector of the robotic insertion tube to the robotic sleeve.
 6. The system of claim 5 wherein the outer access connector of the robotic insertion tube has a compressible seal disposed within a groove in an outer surface of the outer access connector of the robotic insertion tube, the compressible seal and the groove in the outer surface of the outer access connector are disposed above the plurality of pins of the outer access connector and the first robotic sleeve is arranged to be disposed externally to the patient's body.
 7. The system of claim 2 wherein the flexible seal surrounds the inner access connector of the robotic insertion tube and is disposed under the inner access connector of the robotic insertion tube.
 8. The system of claim 2 wherein the flexible seal has a first region with a first thickness surrounding the robotic insertion tube and a second region having a second thickness disposed under the inner access connector of the robotic insertion tube, the first thickness of the flexible seal being greater than the second thickness of the flexible seal to provide a predetermined insertion force.
 9. The system of claim 8 wherein the outer access connector of the robotic insertion tube has a seal on an outer surface of the outer access connector of the robotic insertion tube.
 10. The system of claim 9 wherein the outer access connector of the robotic insertion tube is removably coupled to the inner access connector of the robotic insertion tube.
 11. The system of claim 2 wherein the flexible seal is disposed along and around an outer surface of the inner access connector, the outer surface of the inner access connector extending between a proximal end of the inner access connector and a distal end of the inner access connector and the flexible seal having a resiliency allowing the inner access connector to pivot relative to the sealing cap.
 12. The system of claim 11 wherein the flexible seal has a cavity and a raised portion disposed around and surrounding the cavity, the inner access connector being disposed in the cavity of the flexible seal and the raised portion of the flexible seal being disposed surrounding the outer surface of the inner access connector.
 13. The system of claim 2 wherein the inner access connector has an outer diameter equal to an outer diameter of the outer access connector and the inner access connector comprises a distal base at a distal end of the inner access connector, the distal base having an outer diameter greater than the outer diameter of the outer access connector and the sealing cap further comprising a ring connected to the flexible seal and a distance between the ring and the inner access connector being greater than the outer diameter of the inner access connector.
 14. The system of claim 2 wherein the flexible seal is disposed above and below the distal end of the inner access connector, the flexible seal disposed above the distal end of the inner access connector having a thickness greater than a thickness of the flexible seal disposed below the distal end of the inner access connector.
 15. A surgical robotic access system providing robotic instrument access into a patient's body, the surgical robotic access system comprising: a sealing cap arranged to be disposed externally to a patient's body, the sealing cap including a flexible seal; a robotic insertion tube comprising: a first outer access connector and an inner access connector, the first outer access connector removably coupled to a first robotic sleeve through which a first robotic manipulator is insertable therethrough and the inner access connector is embedded in the flexible seal of the sealing cap to permanently affix the inner access connector to the flexible seal, and a second outer access connector removably coupled to a second robotic sleeve through which a second robotic manipulator is insertable therethrough, the first and second outer access connectors arranged to be removably coupled to the inner access connector of the robotic insertion tube in that the first and second outer access connectors are interchangeable with the inner access connector; wherein the first outer access connector includes a first robotic coupling interface to sealingly mate with a corresponding first robotic coupling interface of the first robotic sleeve and the second outer access connector includes a second robotic coupling interface to sealingly mate with a corresponding second robotic coupling interface of the second robotic sleeve, the first robotic coupling interface of the first outer access connector being different from the second robotic coupling interface of the second outer access connector.
 16. A surgical robotic access providing robotic instrument access into a patient's body, the surgical robotic access system comprising: a sealing cap arranged to be disposed externally to a patient's body, the sealing cap including a flexible seal; a robotic insertion tube comprising: a first outer access connector and an inner access connector, the first outer access connector removably coupled to a first robotic sleeve through which a first robotic manipulator is insertable therethrough and the inner access connector is embedded in the flexible seal of the sealing cap to permanently affix the inner access connector to the flexible seal, and a second outer access connector removably coupled to a second robotic sleeve through which a second robotic manipulator is insertable therethrough, the first and second outer access connectors arranged to be removably coupled to the inner access connector of the robotic insertion tube in that the first and second outer access connectors are interchangeable with the inner access connector; wherein the second outer access connector comprises a plurality of apertures disposed around a periphery of the second outer access connector, the plurality of apertures not extending into a lumen of the second outer access connector and the first robotic sleeve is arranged to be disposed externally to the patient's body.
 17. A surgical robotic access system providing robotic manipulator access into a patient's body, the surgical robotic access system comprising: a sealing cap arranged to be disposed externally to a patient's body, the sealing cap including a flexible seal; a retractor comprising an outer ring removably connected to the sealing cap and an inner ring arranged to be positioned within a patient's body; and a robotic insertion tube comprising an outer access connector and an inner access connector, the outer access connector removably coupled to a robotic sleeve and the inner access connector embedded in the flexible seal of the sealing cap, the robotic insertion tube having a lumen extending through the outer access connector and the inner access connector and the flexible seal covering a portion of the lumen extending through the inner access connector and through which a surgical robotic manipulator insertable through the lumen is insertable through the flexible seal covering the portion of the lumen; wherein the inner access connector comprises a plurality of apertures disposed around a periphery of the inner access connector at a distal portion of the inner access connector through which the flexible seal extends there through to hold the distal portion of the inner access connector in place and permanently affixed in the flexible seal.
 18. A surgical robotic access system providing robotic manipulator access into a patient's body, the surgical robotic access system comprising: a sealing cap arranged to be disposed externally to a patient's body, the sealing cap including a flexible seal; a retractor comprising an outer ring removably connected to the sealing cap and an inner ring arranged to be positioned within a patient's body; and a robotic insertion tube comprising an outer access connector and an inner access connector, the outer access connector removably coupled to a robotic sleeve and the inner access connector embedded in the flexible seal of the sealing cap, the robotic insertion tube having a lumen extending through the outer access connector and the inner access connector and the flexible seal covering a portion of the lumen extending through the inner access connector and through which a surgical robotic manipulator insertable through the lumen is insertable through the flexible seal covering the portion of the lumen; wherein the sealing cap further comprises a ring surrounding and connected to the flexible seal; a insufflation port disposed through the flexible seal and the ring, the insufflation port having an inlet disposed at a periphery of the ring and an outlet disposed below the flexible seal and arranged to supply insufflation gas into a patient; and an evacuation port disposed through the flexible seal and the ring, the evacuation port having an inlet disposed below the flexible seal and an outlet disposed at the periphery of the ring and arranged to extract smoke from a patient. 